News Scan for Jan 15, 2015

News brief

CDC report highlights disease disparities among native people

Of 26 notifiable diseases analyzed for 2007 through 2011, rates were higher in American Indian/Alaska Natives (AI/ANs) than in whites for 14, and for certain diseases the rates in that minority population were dramatically higher, the Centers for Disease Control and Prevention (CDC) reported today.

Writing in Morbidity and Mortality Weekly Report (MMWR), the authors said they used data from the National Notifiable Diseases Surveillance System. They note that, for 20 diseases for which 20,000 or more cases were reported nationally, disease incidence was higher in 9 for AI/ANs. Among the 22 disease for which 70% or more of records had complete race information, incidence rates in AI/ANs exceeded those of whites in 12.

Of those 12 diseases, the largest discrepancy was for hantavirus pulmonary syndrome, for which AI/ANs outpaced whites 15 to 1. The group had 6.8 times the rate of tularemia, 4.2 times the rate of spotted fever rickettsiosis, 2.5 times the rate of Chlamydia infection, 2.4 times the rate of gonorrhea, and 2.1 times the rate of West Nile virus disease.

On the flip side, whites outpaced AI/ANs for varicella (chickenpox, 2.6 times) and cryptosporidiosis (2.2 times).

The authors conclude, "State and local health departments with large segments of AI/AN populations have opportunities to develop efficient intervention efforts and programs tailored to this population."
Jan 16 MMWR report

CDC updates travel advice on Lunar New Year, chikungunya, measles

In anticipation of numerous travelers going to Asia to celebrate the Lunar New Year that begins in February, the CDC this week issued a new travel notice giving tips for staying healthy, among them staying away from farms and bird markets and not touching birds, pigs, or other animals.

Other general tips for safely celebrating the Year of the Goat are to wash hands often and avoid contact with ill people, take measures to prevent mosquito bites, and follow food and water safety guidelines. The CDC stresses choosing safe transportation, saying motor vehicle accidents are the No. 1 cause of death in healthy US citizens traveling abroad.

The notice also encourages travelers to visit their doctor or clinic at least 4 to 6 weeks before departure to discuss specific medicines and immunizations appropriate for the area to be visited.
Jan 13 CDC travel notice

CDC updated a number of notices regarding travel to areas with chikungunya and measles, as well.

Warnings about chikungunya in the Caribbean, Mexico, French Polynesia, and South America, where the disease is running rampant, stress that even one mosquito bite can cause the infection and that preventing bites is the only protection available for fighting the disease, which generally causes fever and joint pain. Members of certain at-risk groups, such as those who are older or who have underlying disease or are pregnant, should discuss travel plans with their doctor, the CDC said.

The agency also updated alerts about measles in the Philippines and Vietnam. The Philippines saw nearly 60,000 suspected cases during 2014, says the CDC, with more than 21,000 of those confirmed and over 100 fatal. Cases among US travelers to the country number 25 as of Dec 20, 2014, most of them in unvaccinated people. The alert stresses the importance of ensuring that travelers, especially infants and children, are vaccinated, and says anyone feeling ill upon their return should make sure they inform caregivers about their recent travel.

Vietnam saw more than 17,000 suspected measles cases in 2014, with over 5,500 confirmed and 2 fatal, says a separate CDC alert. Again, the importance of measles vaccination before travel as well as informing healthcare providers of their travel if they become ill is stressed.
CDC travel notices page

Avian Flu Scan for Jan 15, 2015

News brief

H5N2 found in wild Oregon mallard

In the latest detection of avian flu in wild and domestic birds in Western states, Oregon officials have confirmed the H5N2 strain in a hunter-killed mallard near Eugene, the Oregon Department of Fish and Wildlife (ODFW) said in a news release yesterday.

The female duck was sampled Dec 20 as part of routine ODFW surveillance. Results of confirmatory testing at the National Veterinary Services Laboratory in Ames, Iowa, were relayed to the ODFW on Jan 13. The mallard, which was shot at the Fern Ridge Wildlife Area, showed no signs of sickness.

The release also said there have been no recent reports of waterfowl die-offs in North America. The last one appears to have been in December. On Dec 17, the US Department of Agriculture (USDA) confirmed that H5N2 was found in northern pintail ducks after a die-off at Wiser Lake in northwestern Washington.

H5N2 has also affected several backyard poultry flocks in Washington in recent weeks and a number of commercial farms across the border in British Columbia since early December.

Another avian flu strain—H5N8—has been confirmed in recent weeks in wild birds in Utah and California, a captive gyrfalcon in Washington, and a backyard flock in southwestern Oregon. That strain was also responsible for a series of outbreaks in Europe since November and in more recent ones in South Korea and Taiwan (see item below).
Jan 14 ODFW news release
Dec 17 USDA press release on avian flu in pintails, gyrfalcon

Taiwan reports 4 more H5N8 outbreaks

Taiwan agriculture officials have confirmed 4 new H5N8 avian flu outbreaks on geese farms, bringing to 10 the number of such outbreaks in the past 5 days, according to a report posted today by the World Organization for Animal Health (OIE).

Two of the outbreaks are in Chiayi County, and two are in Yunlin County in the western part of Taiwan. Four of the previous outbreaks have been in Chiayi County, with one each in Yunlin and Pingtung counties, the latter being in the south.

The new outbreaks have affected farms ranging in size from 1,400 to 10,000 geese. From 4 to 3,180 birds have contracted H5N8, with all affected birds dying. The report said plans call for destroying all the birds on the affected farms to prevent disease spread.

All told, 3,298 of 21,600 geese have been infected.
Jan 15 OIE report

Study: H10 evolution in China highlights threat to public health

Twelve years of surveillance of H10 avian flu viruses in poultry and migratory birds in southern China—tracing the origins of the H10N8 and H10N6 strains—demonstrate the severe threat to public health posed by the viruses as they reassort in the fertile influenza ecosystem of China, according to findings of a study yesterday in the Journal of Virology.

The researchers, from several Chinese institutions as well as St. Jude Children's Research Hospital in Memphis, Tenn., carried out systematic surveillance at live-poultry markets (LPMs) and sentinel duck farms in six provinces of southern China as well as in uninhabited areas of Poyang Lake and at farms adjacent to the lake from 2002 to 2014.

They say H10 viruses that began appearing at LPMs in Jiangxi in August 2013 originated from over-wintering migratory ducks sharing the Poyang Lake area with domestic ducks, with shared viruses then transferring to LPMs, where they further reassorted with enzootic avian flu strains.

The authors state that they have isolated 124 H10N8 and H10N6 strains from local LPMs. Phylogenetic analysis has shown that H10N8 in chickens was generated through multiple reassortments between H10 and N8 viruses from domestic ducks and enzootic H9N2 viruses in chickens.

H10N8 has caused at least three human cases in recent months, two fatal.

The more recently seen H10N6 variant may have stemmed from the reassortment of the continually present H10 viruses at LPMs with H5N6 viruses, they add. No human cases have been associated with this strain.

The influenza ecosystem of China, explain the authors, is unique in its huge population of aquatic birds and terrestrial poultry and in the multiple subtypes of flu viruses existent in them, the combination of industrial and mixed-animal backyard farming, and the widespread system of LPMs.

They conclude, "All these factors make China a unique influenza epicentre for generating novel viruses with pandemic potential," and that to reduce the emergence of novel viruses and control current enzootic influenza viruses and the potential emergence of pandemic flu in China, "Revolutionary changes to the entire structure of poultry farming practices, LPMs, and the poultry distribution system are needed."
Jan 14 J Virol study abstract